Alexander G. Nein, MS, M.D.
I'm only 22 and my breasts are very big and saggy. They have no life to them, they're just droopy and low. What can I do?
If your breasts are large and heavy, the weight of them could be contributing to the sagginess. You could consider a breast reduction to decrease the size and weight of the breasts and at the same time they would be lifted on your chest. The nipple complex could be raised and the areolas could be reduced. If you’re having neck and shoulder pain from the weight of the breasts, this too may be improved depending upon how much breast tissue is reduced.
You’ll need to consider this option carefully because the surgery will leave some scars on the breasts. These scars tend to heal well and would be covered by any clothing you would wear in public. The vast majority of women are extremely pleased with the results of a breast reduction. It becomes easier to find clothing that fits comfortably, sporting activities become easier and of course the load on the neck and shoulders is reduced.
Long term support of the breasts will help maintain the results you get from surgery. Wearing a properly fitted bra that supports the weight of the breasts (especially if and when you may become pregnant) will reduce the effects of gravity over time.
Consult a board certified plastic surgeon to discuss all your options.
Can I get silicone breast implants placed under the muscle or do they have to be on top like my current saline ones?
I had silicone implants 20 years ago, under the muscle. I was having lots of pain and burning in 1990. I was sent for an MRI then informed of a rupture. I had them removed and replaced with saline on top of muscle. I was just in a car accident that caused one of my implants to rupture. Can I get silicone placed under the muscle or does it have to be on top such as my saline ones are currently? Also is it more probable that since I've had to have so many surgeries that my scar tissue will be worse therefore causing encapsulation?
Yes, you certainly can have your saline implants replaced with silicone implants and they can be placed under the muscle. Although there is some additional scar tissue as a result of the previous surgeries, it will probably not have any influence on your risk of developing capsular contracture. The scar tissue that exists can be appropriately managed at the time of your surgery. Be sure to consult a plastic surgeon who is certified by the American Board of Plastic surgery and has experience in breast surgery revisions.
I know the breast changes during lactation. How long after ceasing to breast feed (I am done having children) should I wait to see a surgeon and have a breast reduction performed?
My recommendation is to wait for 6 months or more after stopping breast feeding before having a breast reduction performed. That will give your breasts enough time to readjust after all the hormonal influences from pregnancy and lactation have settled down. At that point it will be easier for you and your plastic surgeon to best determine how much breast tissue should be removed to get you the result that you desire.
I am 34 yrs of age and I had breast implants 13 years ago. I have noticed they have dropped and my nipples are pointing downward. Can I leave the implants in and get a lift because I don't want to go any bigger or should I have the implants replaced? Please help!
If you are happy with the size, position and softness of the implants, then you could simply leave them alone and not replace them. You could have a lift performed, leaving the current implants as they are. However, implants are mechanical devices and are not considered lifetime devices. At some point, they will probably develop a leak and require replacement. Unfortunately, no one knows whether for you that will be in five days, five months, five years or fifteen years. It is unpredictable. Since you are already undergoing a surgical procedure, it would reasonable to replace the existing implants because they are after all thirteen years old.
An important piece of information would be whether the implants you have are under manufacturer warranty. About the time you had your implants placed, some of the major implant manufacturers began to offer lifetime warranties. If your implants happen to be covered and they were to develop a leak then you would be covered. If you have them replaced while they are intact you’ll have to pay for new implants and you would not benefit from the warranty. On the other hand, all the major U.S. manufacturers now offer a lifetime warranty on their implants. If you replace your implants with implants from one of these companies, you would then be covered by their warranty. This could be especially valuable to you if your current implants do not have a warranty.
There is no “right” or “wrong” answer. There are choices and the decision rests with what you are comfortable with. Discuss all the choices, implications and costs with your board certified plastic surgeon and decide what is best for you.
I am losing weight and I am ready to enlarge my breasts. Will I be allowed to get the surgery if I weigh 250 pounds?
Your weight is not critical in determining if you can have a breast augmentation. What is important is that you are healthy enough for the surgery and that you have realistic expectations and goals. For example, if you are on a dieting program and expect to lose 20 or more lbs, then it might be wise to delay breast surgery until you are nearer your target weight. The reason is that as your weight changes significantly, your breast size will also change. Consequently, if you have surgery done too soon in this process, your needs or desires in terms of implant size may change.
Consult a plastic surgeon certified by the American Board of Plastic Surgery and he or she can discuss your desires and formulate a plan to help you get the results that you want.